Effect of closed suction irrigation on patients with brucellosis spondylitis after one-stage posterior debridement and bone grafting fusion with internal fixation: a randomized controlled trial

Abstract

Abstract Objective: Currently, the treatment of brucellosis spondylitis (BS) is still a major clinical problem. The purpose of this study is to evaluate the feasibility of closed suction irrigation on patients with BS after one-stage posterior debridement and bone grafting fusion with internal fixation. Methods: This is a single blind randomized clinical controlled trial. A total of 30 patients with BS after one-stage posterior debridement and bone grafting fusion with internal fixation admitted from August 2022 to March 2023 were randomly divided into control group and experimental group according to the ratio of 1:1, with 15 patients in each group. The control group was treated with routine antibiotic therapy after operation, the experimental group was treated with gentamicin closed suction irrigation at the basis of the control group. From the first day after operation, the wound was continuously washed with 80mg gentamicin +3000ml normal saline once a day for 2 weeks. By the third week, stop suction irrigation and continue to receive routine antibiotic treatment. The inflammatory markers [erythrocyte sedimentation rate (ESR), C- reactive protein (CRP)], the visual analogue scale (VAS) and oswestry disability index (ODI) were observed before operation, the 1st day after operation, and 1-week and 2-week after intervention. Multiple interpolation for missing data. Results: Intention-to-treat analysis was used. All were analyzed in their randomized group. The results showed that the inflammatory markers, VAS and ODI in both groups decreased after 1-week of intervention (P<0.001), and the experimental group decreased significantly compared with the control group (P<0.05 or P<0.01). After 2-week of intervention, these significant differences still existed, and a significant difference compared with the 1-week (P<0.001). In addition, after 2-week of intervention, the ESR of patients in the experimental group decreased to a low level before operation (P<0.001), but the control group did not find this change. There were no adverse events were observed during the study. All patients were discharged with bone graft fusion degree of Grade 3. No postoperative complications occurred and the incision healed well. Conclusion: Closed suction irrigation of gentamicin is safe and feasible for patients with BS after one-stage posterior debridement and bone grafting fusion with internal fixation, which can reduce inflammatory markers, relieve pain and improve functional ability.